Provider Demographics
NPI:1790197903
Name:LUGO-NERIS, MIRZA JEANNETTE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRZA
Middle Name:JEANNETTE
Last Name:LUGO-NERIS
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17306 ORWELL LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7415
Mailing Address - Country:US
Mailing Address - Phone:787-510-0370
Mailing Address - Fax:
Practice Address - Street 1:2504A WHITIS AVE
Practice Address - Street 2:SUITE 2.202 (MAIL CODE A1100)
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-0114
Practice Address - Country:US
Practice Address - Phone:512-232-1503
Practice Address - Fax:512-471-2957
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist